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General NPI Number Information
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NPI Number | 1003936618
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Entity Type | Individual
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Provider Name | ANTONIO LEE COVELLO JR. SA-C
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 5183 S COOLIDGE ST
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City | AURORA
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State | CO
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Zip | 80016-4023
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Country | US
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Telephone | 720-837-7992
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Fax | 303-955-6464
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Provider Business Mailing Address
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Address Line | 21200 S LAGRANGE RD STE 322
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City | FRANKFORT
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State | IL
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Zip | 60423-2003
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Country | US
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Telephone | 720-837-7992
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Fax | 303-955-6464
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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